RT Journal
A1 Day JC, Bentall RP, Roberts C, et al
T1 Attitudes toward antipsychotic medication: The impact of clinical variables and relationships with health professionals
JF Archives of General Psychiatry
JO Archives of General Psychiatry
YR 2005
FD July 1
VO 62
IS 7
SP 717
OP 724
DO 10.1001/archpsyc.62.7.717
UL http://dx.doi.org/10.1001/archpsyc.62.7.717
AB Context
Nonadherence to antipsychotic medication is a major cause of psychotic relapse and is strongly influenced by attitudes toward treatment. Although patient variables such as insight and symptoms that contribute toward attitudes have been identified, the contributions of relationship and service factors have not been adequately studied.Objective
To determine relations between clinical and service variables and attitudes toward medication in people with a diagnosis of schizophrenia and schizoaffective disorder.Design
Consecutively admitted patients were approached to take part; 23 refused. Measures included symptoms, insight, drug adverse effects, self-reported adherence, attitudes toward treatment, perceived relationship with the prescriber, ward atmosphere, and admission experience. Data were analyzed by a proportional odds model and structural equation modeling to test predicted paths between experience of admission, relationship variables, attitudes toward treatment, and self-reported adherence to medication.Setting
Twenty-eight inpatient wards at 8 hospitals in North Wales and the Northwest of England. Sites included hospitals with inner-city and rural catchment areas.Patients
Two hundred twenty-eight patients meeting DSM-IV criteria for schizophrenia or schizoaffective disorder, assessed during acute admission.Main Outcome Measures
Attitudes toward treatment and self-reported adherence to medication.Results
The data fit a model in which attitudes toward treatment were predicted by insight, relationship with staff (especially the physician-prescriber), and the patient’s admission experience (maximum likelihood χ249 = 89.3, P<.001). A poor relationship with the prescriber, experience of coercion during admission, and low insight predicted a negative attitude toward treatment.Conclusions
The quality of relationships with clinicians during acute admission appears to be an important determinant of patients’ attitudes toward treatment and adherence to medication. Enhancing such relationships may yield important clinical benefits.